|
REPAIR OF RUPTURED TENDON
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
76100521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
REPAIR OF RUPTURED TENDON
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
76100521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$618.43 |
| Max. Negotiated Rate |
$1,273.78 |
| Rate for Payer: Aetna Commercial |
$1,159.68
|
| Rate for Payer: Ambetter Exchange |
$738.27
|
| Rate for Payer: Anthem Medicaid |
$618.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$738.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$738.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$885.92
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,273.78
|
| Rate for Payer: Healthspan PPO |
$1,050.42
|
| Rate for Payer: Humana Medicaid |
$618.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$966.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$738.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$738.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$630.80
|
| Rate for Payer: Molina Healthcare Passport |
$618.43
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$959.75
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$624.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$738.27
|
|
|
REPAIR OF RUPTURED TENDON
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
76100521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
REPAIR OF RUPTURED TENDON(P
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
761P0521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$618.43 |
| Max. Negotiated Rate |
$1,273.78 |
| Rate for Payer: Aetna Commercial |
$1,159.68
|
| Rate for Payer: Ambetter Exchange |
$738.27
|
| Rate for Payer: Anthem Medicaid |
$618.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$738.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$738.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$885.92
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,273.78
|
| Rate for Payer: Healthspan PPO |
$1,050.42
|
| Rate for Payer: Humana Medicaid |
$618.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$966.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$738.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$738.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$630.80
|
| Rate for Payer: Molina Healthcare Passport |
$618.43
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$959.75
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$624.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$738.27
|
|
|
REPAIR OF THIGH
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
HCPCS 27470
|
| Hospital Charge Code |
76102818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.75 |
| Max. Negotiated Rate |
$1,909.10 |
| Rate for Payer: Aetna Commercial |
$1,761.80
|
| Rate for Payer: Ambetter Exchange |
$1,120.71
|
| Rate for Payer: Anthem Medicaid |
$945.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,120.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,120.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,344.85
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,909.10
|
| Rate for Payer: Healthspan PPO |
$1,595.81
|
| Rate for Payer: Humana Medicaid |
$945.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,120.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,120.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$964.07
|
| Rate for Payer: Molina Healthcare Passport |
$945.17
|
| Rate for Payer: Multiplan PHCS |
$723.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,456.92
|
| Rate for Payer: UHCCP Medicaid |
$421.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$954.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,120.71
|
|
|
REPAIR OF THIGH
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS 27470
|
| Hospital Charge Code |
76102818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
REPAIR OF THIGH
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS 27470
|
| Hospital Charge Code |
76102818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem Medicaid |
$414.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Humana KY Medicaid |
$414.40
|
| Rate for Payer: Kentucky WC Medicaid |
$418.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
REPAIR OF THIGH MUSCLE
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 27385
|
| Hospital Charge Code |
76100831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$555.00 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Aetna Commercial |
$1,424.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,535.50
|
| Rate for Payer: First Health Commercial |
$1,757.50
|
| Rate for Payer: Humana Commercial |
$1,572.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.50
|
| Rate for Payer: PHCS Commercial |
$1,776.00
|
| Rate for Payer: United Healthcare All Payer |
$1,628.00
|
|
|
REPAIR OF THIGH MUSCLE
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 27385
|
| Hospital Charge Code |
76100831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.00 |
| Max. Negotiated Rate |
$1,110.00 |
| Rate for Payer: Aetna Commercial |
$920.44
|
| Rate for Payer: Ambetter Exchange |
$573.16
|
| Rate for Payer: Anthem Medicaid |
$482.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$573.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$573.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$687.79
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,023.95
|
| Rate for Payer: Healthspan PPO |
$833.72
|
| Rate for Payer: Humana Medicaid |
$482.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$779.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$573.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$491.64
|
| Rate for Payer: Molina Healthcare Passport |
$482.00
|
| Rate for Payer: Multiplan PHCS |
$1,110.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$745.11
|
| Rate for Payer: UHCCP Medicaid |
$647.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$486.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$573.16
|
|
|
REPAIR OF THIGH MUSCLE
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 27385
|
| Hospital Charge Code |
76100831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.22 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,424.50
|
| Rate for Payer: Anthem Medicaid |
$636.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,535.50
|
| Rate for Payer: First Health Commercial |
$1,757.50
|
| Rate for Payer: Humana Commercial |
$1,572.50
|
| Rate for Payer: Humana KY Medicaid |
$636.22
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$642.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$648.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.50
|
| Rate for Payer: PHCS Commercial |
$1,776.00
|
| Rate for Payer: United Healthcare All Payer |
$1,628.00
|
|
|
REPAIR OF THIGH MUSCLE(P
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 27385
|
| Hospital Charge Code |
761P0831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.00 |
| Max. Negotiated Rate |
$1,110.00 |
| Rate for Payer: Aetna Commercial |
$920.44
|
| Rate for Payer: Ambetter Exchange |
$573.16
|
| Rate for Payer: Anthem Medicaid |
$482.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$573.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$573.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$687.79
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,023.95
|
| Rate for Payer: Healthspan PPO |
$833.72
|
| Rate for Payer: Humana Medicaid |
$482.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$779.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$573.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$491.64
|
| Rate for Payer: Molina Healthcare Passport |
$482.00
|
| Rate for Payer: Multiplan PHCS |
$1,110.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$745.11
|
| Rate for Payer: UHCCP Medicaid |
$647.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$486.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$573.16
|
|
|
REPAIR OF URETHRAL LESION
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 57230
|
| Hospital Charge Code |
76102855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.32 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem Medicaid |
$151.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Humana KY Medicaid |
$151.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$152.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.60
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
REPAIR OF URETHRAL LESION
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 57230
|
| Hospital Charge Code |
76102855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$595.55 |
| Rate for Payer: Aetna Commercial |
$595.55
|
| Rate for Payer: Ambetter Exchange |
$393.83
|
| Rate for Payer: Anthem Medicaid |
$267.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$393.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$393.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$472.60
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$567.51
|
| Rate for Payer: Healthspan PPO |
$576.65
|
| Rate for Payer: Humana Medicaid |
$267.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$518.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$393.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$272.67
|
| Rate for Payer: Molina Healthcare Passport |
$267.32
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$511.98
|
| Rate for Payer: UHCCP Medicaid |
$154.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$269.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$393.83
|
|
|
REPAIR OF URETHRAL LESION
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 57230
|
| Hospital Charge Code |
76102855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.60
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
REPAIR OF WINDPIPE DEFECT
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 31825
|
| Hospital Charge Code |
41000064
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$248.65 |
| Max. Negotiated Rate |
$754.65 |
| Rate for Payer: Aetna Commercial |
$754.65
|
| Rate for Payer: Ambetter Exchange |
$457.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$248.65
|
| Rate for Payer: Anthem Medicaid |
$333.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$457.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$457.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$549.20
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$697.01
|
| Rate for Payer: Healthspan PPO |
$713.33
|
| Rate for Payer: Humana Medicaid |
$333.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$621.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$457.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$340.03
|
| Rate for Payer: Molina Healthcare Passport |
$333.36
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$594.97
|
| Rate for Payer: UHCCP Medicaid |
$261.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$457.67
|
|
|
REPAIR OF WINDPIPE DEFECT
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 31825
|
| Hospital Charge Code |
41000064
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REPAIR OF WINDPIPE DEFECT
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 31825
|
| Hospital Charge Code |
41000064
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REPAIR OF WINDPIPE DEFECT(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 31825
|
| Hospital Charge Code |
410P0064
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$248.65 |
| Max. Negotiated Rate |
$754.65 |
| Rate for Payer: Aetna Commercial |
$754.65
|
| Rate for Payer: Ambetter Exchange |
$457.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$248.65
|
| Rate for Payer: Anthem Medicaid |
$333.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$457.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$457.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$549.20
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$697.01
|
| Rate for Payer: Healthspan PPO |
$713.33
|
| Rate for Payer: Humana Medicaid |
$333.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$621.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$457.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$340.03
|
| Rate for Payer: Molina Healthcare Passport |
$333.36
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$594.97
|
| Rate for Payer: UHCCP Medicaid |
$261.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$457.67
|
|
|
REPAIR OSTEOCHOND SUB DRILL
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
|
|
REPAIR OSTEOCHOND SUB DRILL
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
REPAIR OSTEOCHOND SUB DRILL
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 27650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON; WITH GRAFT (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 27652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; COLLATERAL
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 27405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
REPAIR RADIUS OR ULNA
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 25400
|
| Hospital Charge Code |
76100611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$633.90 |
| Max. Negotiated Rate |
$1,656.26 |
| Rate for Payer: Aetna Commercial |
$1,280.29
|
| Rate for Payer: Ambetter Exchange |
$764.94
|
| Rate for Payer: Anthem Medicaid |
$633.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$764.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$764.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$917.93
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,656.26
|
| Rate for Payer: Healthspan PPO |
$1,159.67
|
| Rate for Payer: Humana Medicaid |
$633.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,037.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$764.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$764.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$646.58
|
| Rate for Payer: Molina Healthcare Passport |
$633.90
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$994.42
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$640.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$764.94
|
|
